Ostomy Management

By Janis E. Harrison, RN, BSN, CWOCN, CFCN My Path to Becoming a Wound, Ostomy and Continence Nurse "What did I get myself into?" There were several times over the first 10 years of my 20 year marriage to a person with an ostomy that I had to ask myself that question. Then came the revelation of the old saying "if you can't beat 'em…. join 'em." I decided that after major problems my spouse had with several surgeries – which included ostomy revisions, fistulae, abscesses, and surgical wounds – I would need to learn much, much more if I was going to spend the rest of my life with my husband, Daryl, and his maladies.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA My current job as wound coordinator has pulled me into the world of incontinence and the many disciplines that care for people challenged by this disorder. I was previously acquainted with the therapy side as I worked with therapists certified in pelvic floor therapy. My work with venous edema acquainted me with medications that caused continence-challenged people to resort to absorbent adult briefs. As I work more closely with physicians, I am more familiar with medications to support weakened or sensitive pelvic muscles and nerves. On the nursing side, I have researched support surfaces, incontinence pads, and barrier creams. I see patients and occupational therapists working together to regain continence independence through problem-solving mobility issues.

By Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN Happy Spring! At least that is what the calendar indicates, but recent temperatures across much of the US seem to dispute that fact.

Peristomal skin complications (PSCs) include inflammation, injury, or damage to the skin surrounding an abdominal stoma. PSCs are among the most common challenges faced by people living with an ostomy, with as high as 80% reported incidence. Complications are highest in individuals with an ileostomy.  Some of the most common PSCs in individuals with stomas for fecal diversion

Ivy Razmus, RN, PhD, CWOCN Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.

By Aletha Tippett MD For over a decade now I have treated wounds in palliative care patients and non-palliative care patients. The “funny” thing is that there is no difference in how I treat these wounds, all are approached the same way, with similar treatments used. As I teach more and more about palliative wound care, it seems obvious to me that all wounds and all people deserve this approach. Who does not deserve less pain? Who deserves to be embarrassed by wound odor? Who deserves to have an infection? Who deserves a lesser quality of life? When asked these questions I would think the answer would be NO ONE.

By: Dianne Rudolph, DNP, GNP-BC, CWOCN What are some ways to achieve insurance coverage for fistula pouches or to use ostomy supplies for a fistula? We often run into the issue of supplies not being covered for Medicare or Medicaid patients. Unfortunately, coverage is inadequate. CMS (Centers for Medicare & Medicaid Services) coverage for fistulas is limited for fistulas caused by or resulting from a surgical procedure, and even then, it may be difficult to get reimbursed. Spontaneous fistulas (15% to 25%) are generally not covered. The Wound, Ostomy and Continence Society is working on trying to effect a change in coverage. Some insurance companies may be more amenable to reimbursement, and it may require a case-by-case application or appeal. For patients being discharged home, it may be possible to secure a short-term supply of 10 to 14 days. The cost for the pouches may run $255 and up for a box of 10.

By Holly M. Hovan, MSN, RN-BC, APRN, CWOCN-AP As someone who holds tricertification, I often feel as though my ostomy patients are the ones in whose lives I am making the biggest difference. Watching them progress, gain confidence in independent ostomy management, and enjoy their lives once again is one of the best feelings to me!

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS Public policy is an aspect that affects every day practice for most wound, ostomy and continence nurses, but is something that we do not generally think about. One health policy topic that is in the forefront of my mind is how the Centers for Medicare and Medicaid Services (CMS) is looking to change the process for how patients access or DME products. This change in public policy would affect the access of these necessary products to our patients.

B Janis E. Harrison, RN, BSN, CWOCN, CFCN My husband was insistent that I go home the first night he was on the surgical floor. He had a roommate, therefore the hospital policy forbade me to stay the night with him.